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NPI Code Detail

MEDICARE: FREEDOM PHARMACY LLC

MEDICARE: FREEDOM PHARMACY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail PharmacyPP481827PA

General Provider Information

NPI Number : 1942687116
Entity Type Code : Organization
Provider Name (Legal Business Name) : FREEDOM PHARMACY LLC
Provider Business Mailing Address
First Line : 3605 EDGMONT AVE
Second Line : BUILDING B
City : BROOKHAVEN
State : PA
Zip : 19015-2807
Country : US
Telephone Number : 855-539-7865
Fax Number : 866-250-1718
Provider Business Practice Location Address
First Line : 3605 EDGMONT AVE
Second Line : BUILDING B
City : BROOKHAVEN
State : PA
Zip : 19015-2807
Country : US
Telephone Number : 855-539-7865
Fax Number : 866-250-1718
Authorized Official
Title or Position : PHARMACY MANAGER
Name : MRS. KELLY A WICK
Credential : RPH
Telephone Number : 855-539-7865
Provider Enumeration Date : 04/27/2015
Last Update Date : 01/25/2017

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Directions to “FREEDOM PHARMACY LLC ” Practice Location

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